Introduction to acute mastoiditis

Mastoiditis is a suppurative infection of the mastoid air cells within the temporal bone. It can be acute (symptoms present for less than 1 month) or chronic (symptoms present for months to years). The most common pathogens are Streptococcus pneumoniae, Streptococcus pyogenes (group A streptococcus), Haemophilus influenzae and Staphylococcus aureusSmith 2022.

Acute mastoiditis is most common in children younger than 2 years but can occur at any ageCarmel 2017Gelbart 2019Mather 2020Smith 2022. Complications are seen in approximately 10 to 20% of cases and generally involve structures close to the mastoid (eg the facial nerve, jugular vein, internal carotid artery, sigmoid sinus, meninges, brain). Complications of mastoiditis can be intratemporal (eg subperiosteal abscess, hearing loss, facial paralysis, labyrinthitis) or intracranial (eg sigmoid sinus thrombosis, meningitis, sub- and extra-dural collections, intracranial abscesses)Gelbart 2019Loh 2018Mather 2020Smith 2022Vergadi 2021.

In children, mastoiditis is a rare complication of acute otitis media. It is important to distinguish mastoiditis from acute otitis media (in which the temporal bone is not infected).

This topic addresses the diagnosis and management of acute mastoiditis in children. For management of chronic mastoiditis in children, seek expert advice. Detailed advice on the management of mastoiditis in adults is beyond the scope of these guidelines – seek expert advice.

In adults, mastoiditis can be a complication of chronic suppurative otitis media or cholesteatoma. Management is usually surgical – refer the patient to an otolaryngologist. If a diagnosis of mastoiditis is suspected in an adult without chronic otitis media or cholesteatoma, seek advice from an otolaryngologist or infectious diseases physician. A bone scan may be necessary to exclude necrotising (malignant) otitis externa.